1871749168 NPI number — MICHAL W MANKOWSKI P.T.

Table of content: MICHAL W MANKOWSKI P.T. (NPI 1871749168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871749168 NPI number — MICHAL W MANKOWSKI P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANKOWSKI
Provider First Name:
MICHAL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871749168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2909 CHESTNUT HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-750-9392
Provider Business Mailing Address Fax Number:
410-750-8931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 FREDERICK RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-8698
Provider Business Practice Location Address Fax Number:
410-744-8699
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  15445 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03186 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 062318101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22309 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5800456 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 18692 . This is a "KAISER PERMANENTE MID-ATLANTIC STATES" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2143999 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 22309 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R7760001 . This is a "CAREFIRST BLUECROSS/BLUE SHIELD FEDERAL EMPLOYEES PROGRAM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R776 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1027 . This is a "BRAVO HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 22309 . This is a "M.D. IPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 22309 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521419637 . This is a "MULTIPLAN PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J512 . This is a "CAREFIRST BLUE CROSS/BLUE SHIELD OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 146173400 . This is a "O.W.C.P." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8010223PT . This is a "CIGNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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